Healthcare Provider Details

I. General information

NPI: 1033984398
Provider Name (Legal Business Name): MR. DONALD RAYMOND BALTAZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 WALNUT ST STE G
RED BLUFF CA
96080-3611
US

IV. Provider business mailing address

1850 WALNUT ST STE G
RED BLUFF CA
96080-3611
US

V. Phone/Fax

Practice location:
  • Phone: 530-526-4924
  • Fax: 530-527-0766
Mailing address:
  • Phone: 530-526-4924
  • Fax: 530-527-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-HPGFWS
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: